3800 RIVERFRONT BLVD 2021-01-28 - Laserfiche WebLink

I ISection C-Certification and Signature(CGP Part 5.4.3) Section C.1 -Certification and Signature by Contractor or Subcontractor I - "I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information Isubmitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information,the information submitted is, to the best of my knowledge and belief,true,accurate,and complete. I am aware that there are significant penalties for submitting false information,including the possibility of fine and imprisonment for knowing violations." Signature of Contractor or Subcontractor: Date: Printed Name and Affiliation: ISection C.2-Certification and Signature by Permittee I "I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information,the information submitted is, to the best of my knowledge and belief,true,accurate,and Icomplete. I am aware that there are significant penalties for submitting false information,including the possibility of fine and imprisonment for knowing violations." ISignature of Permittee or "Duly Authorized Representative": Date: Printed Name and Affiliation: I I I I I I I I Page 2 of 2 I